NPIMap

Organization Active NPI

Fontana Family Dentistry

  • General Practice Dentistry
  • Fontana, WI
National Provider Identifier
1811059041
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
FONTANA FAMILY DENTISTRY
Practice address
450 Mill St Ste 101
Fontana, WI 53125-1242
Phone
(262) 275-8080
Fax
(262) 275-5890
NPI assigned
Dec 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Genie Kubel
Title
Contact Officer
Phone
(920) 450-0157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

450 Mill St Ste 101
Fontana, WI 53125-1242

Mailing address

450 Mill St Ste 101
Fontana, WI 53125-1242
Phone (262) 275-8080

National Provider Directory

National Provider Directory

Locations

450 Mill St
#101
Fontana, WI 53125
Phone (262) 275-8080

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811059041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 MILL ST STE 101",
            "city": "FONTANA",
            "state": "WI",
            "postal_code": "531251242",
            "telephone_number": "262-275-8080",
            "fax_number": "262-275-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 MILL ST STE 101",
            "city": "FONTANA",
            "state": "WI",
            "postal_code": "531251242",
            "telephone_number": "262-275-8080",
            "fax_number": "262-275-5890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FONTANA FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUBEL",
        "authorized_official_first_name": "GENIE",
        "authorized_official_title_or_position": "CONTACT OFFICER",
        "authorized_official_telephone_number": "920-450-0157"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.